Form U5 Instructions - FINRA

1 Rev. form U5 (05/2009) form U5 Uniform Termination Notice for Securities Industry Registration GENERAL Instructions The form U5 is the Uniform Termination Notice for Securities Industry Registration. Broker-dealers, investment advisers, or issuers of securities must use this form to terminate the registration of an individual in the appropriate jurisdictions and/or self-regulatory organizations ("SROs"). These Instructions apply to the filing of form U5 electronically with the Central Registration Depository ("CRD ") or the Investment Adviser Registration Depository ("IARDSM"). Filers submitting paper filings should read the Special Instructions for Paper Filers in conjunction with the other Instructions to the form . In addition, paper filers should contact the appropriate jurisdiction and/or SRO for specific filing Instructions or requirements.

2 Filers must answer all questions and submit all requested information, unless otherwise directed in the Specific Instructions . Only Section 2 (CURRENT RESIDENTIAL ADDRESS), the Reason for Termination and/or Termination Explanation in Section 3 (FULL TERMINATION), Section 4 (DATE OF TERMINATION), Section 7 (DISCLOSURE QUESTIONS) and Disclosure Reporting Page(s) (DRPs U5) may be amended on this form U5. If the form U5 has been completed for a full termination, a copy of this form and any subsequent amendments thereto, must be provided to the terminated individual. For full termination filings, complete Section 7 (DISCLOSURE QUESTIONS) and use the Disclosure Reporting Page(s) (DRPs U5) to provide details to the "Yes" answers. Firms may select the optional Disclosure Certification Checkbox if there is no new information to report in Section 7.

3 (See Specific Instructions and the form for further details). For partial terminations, disclosures should be made through the form U4. Upon request, additional documents may be required to clarify or support responses to the form . Firms are under a continuing obligation to amend and update Section 7 (DISCLOSURE QUESTIONS) until final disposition, including reportable matters that occur and become known after initial submission of this form . Amendments must be filed electronically (unless the filer is an approved paper filer) by updating the appropriate section of form U5. The Sections of the form U5 are as follows: 1. GENERAL INFORMATION 2. CURRENT RESIDENTIAL ADDRESS 3. FULL TERMINATION 4. DATE TERMINATED 15. PARTIAL TERMINATION 5A. SRO PARTIAL TERMINATION 5B. JURISDICTION PARTIAL TERMINATION 6. AFFILIATED FIRM TERMINATION 7. DISCLOSURE QUESTIONS (Full Terminations and Amendments Only) INVESTIGATION DISCLOSURE (Question 7A) INTERNAL REVIEW DISCLOSURE (Question 7B) CRIMINAL DISCLOSURE (Question 7C) REGULATORY ACTION DISCLOSURE (Question 7D) customer COMPLAINT/ARBITRATION/CIVIL LITIGATION DISCLOSURE (Question 7E) TERMINATION DISCLOSURE (Question 7F) 8.

4 SIGNATURE 8A. FIRM ACKNOWLEDGMENT 8B. INDIVIDUAL ACKNOWLEDGMENT AND CONSENT DISCLOSURE REPORTING PAGES (DRPs U5) (Full Terminations and Amendments Only) CRIMINAL DRP customer COMPLAINT/ARBITRATION/CIVIL LITIGATION DRP INTERNAL REVIEW DRP INVESTIGATION DRP REGULATORY ACTION DRP TERMINATION DRP 2 SPECIFIC Instructions for completing the form U5 NOTICE TO THE INDIVIDUAL WHO IS THE SUBJECT OF THIS FILING Note: Even if you are no longer registered, you continue to be subject to the jurisdiction of regulators for at least two years after your registration is terminated and may have to provide information about your activities while associated with this firm. Therefore, you must forward any residential address changes for two years following your termination date or last form U5 amendment to: CRD Address Changes, CRD Box 9495, Gaithersburg, MD 20898-9495.

5 1. GENERAL INFORMATION SECTION First Name Enter the individual's first name. Do not use nicknames or abbreviations or make modifications to the individual's first name. Middle Name If the individual has a middle name, specify the full middle name. Do not use nicknames or abbreviations or make modifications to the individual's middle name. If the individual does not have a middle name, leave this field blank. Last Name Enter the individual's last name. Do not use nicknames or abbreviations or make modifications to the individual's last name. Include punctuation when and where appropriate. Suffix Enter any suffix that follows the individual's last name, such as Jr., Sr., etc. Include punctuation when and where appropriate. Firm CRD Number Enter the Firm CRD Number. Firm Name Enter the firm's complete name as listed on the form BD or the form ADV. Do not abbreviate, shorten, or modify the firm name in any way. Firm NFA Number If this form will be filed with the National Futures Association (NFA), enter the firm's assigned, unique NFA registration number in this field.

6 Firm Billing Code The firm billing code will prepopulate based on the information provided on the form U4. If the information is incorrect, file a form U4 amendment prior to submitting the form U5. Individual CRD Number Enter the assigned Individual CRD number. Individual SSN Enter the individual's Social Security Number in this field. If the individual does not possess a CRD number or a Social Security number, please contact FINRA 's Gateway Call Center. Individual NFA Number If this form will be filed with the National Futures Association (NFA), enter the individual's assigned, unique NFA registration number in this field. Office of Employment Address Street 1/Street 2. 3 The office of employment address will prepopulate based on the information provided on the form U4. If the information is incorrect, file a form U4 amendment prior to submitting the form U5. Private Residence Check Box Check this box if the Office of Employment address is a private residence.

7 NOTICE TO THE FIRM This is the last reported residential address. If this is not current, please enter the current residential address. 2. CURRENT RESIDENTIAL ADDRESS Complete this section for both full termination and partial termination requests. Provide the individual's current residential address. Report changes as they occur. From (MM/YYYY) Enter the month and year the individual began residing at this address. Street Address 1/Address 2 Enter the individual's street address here. Post office boxes are not acceptable. Include the street name; building name or number; and unit, suite, apartment or condominium number, as applicable; as well as other identifying information. City Enter the city of residence relating to this address. State Enter the state of residence relating to this address. Country Enter the name of the country of residence for this address. Postal Code Enter the postal code for this address.

8 3. FULL TERMINATION A "yes" response will terminate ALL registrations with all SROs and all jurisdictions. For a full termination, complete the Reason for Termination and Termination Explanation (if the reason for termination is Permitted to Resign, Discharged or Other) and Section 4 (DATE OF TERMINATION). Do not complete Section 5 (PARTIAL TERMINATION). For a partial termination, check "no" and complete Section 5 (PARTIAL TERMINATION). Firms should file amendments to the Reason for Termination and/or Termination Explanation promptly. When filing an amendment to the Reason for Termination and/or Termination Explanation, firms must explain the basis for the amendment. Reason for Termination (Full Terminations Only) For a full termination, provide the reason for termination from the following selections: "Voluntary," "Deceased," "Permitted to Resign," "Discharged," or "Other." If "Permitted to Resign," "Discharged," or "Other," is checked, provide an explanation in the space provided.

9 4. DATE OF TERMINATION (Full and Partial Terminations) For full termination, enter the date the firm terminated the individual's association with the firm in a capacity for which registration is required. 4 For partial termination, enter the date of termination only for post-dated termination requests during the renewal period. Provide the month, day, and year (MM/DD/YYYY). A complete entry must be made in this section. For full termination, this date is used by SROs/jurisdictions to determine whether an individual is required to requalify by examination or obtain an appropriate waiver upon reassociating with another firm. The SRO/jurisdiction determines the effective date of termination of registration. Firms should file amendments to the date of termination promptly. When filing an amendment to the Date of Termination, firms must explain the basis for the amendment. 5. PARTIAL TERMINATION For a partial termination, do not complete the Reason for Termination in Section 3 (FULL TERMINATION) or Section 7 (DISCLOSURE QUESTIONS).

10 The Reason for Termination and Section 7 (DISCLOSURE QUESTIONS) should only be completed on form U5 for full termination requests. 5A. SRO PARTIAL TERMINATION Investment adviser representative (RA) only applicants may skip this section. Check the appropriate boxes to indicate the SROs and registration categories the individual seeks to terminate. Refer to the individual's current CRD record for categories that may be terminated. The individual must retain registration with at least one SRO unless the firm is an intra-state broker-dealer. "Other" Box See Special Instructions for Paper Filers. 5B. JURISDICTION PARTIAL TERMINATION Select the type of registration: broker-dealer agent (AG) and/or an investment adviser representative (RA). To terminate registration as an AG or an RA, select the appropriate jurisdiction(s). Agent of an Issuer To terminate an Agent of the Issuer (AI) registration with one or more jurisdictions, contact the appropriate jurisdiction(s) for Instructions .